How satisfied are you with: (please click on your response)
Telephone Service
1. Ease of contacting the office and staff
2. Instructions for making a selection related to the purpose of your call.
3. Duration of time that you are on hold waiting for somebody to answer or to access voice mail.
4. Timeliness in returning your phone messages.
5. Courtesy of staff that answers your calls.
Appointments
6. My appointment date was available within a reasonable period of time.
7. Friendliness and courtesy of the reception staff.
8. Waiting time in the reception area.
9. Care and assistance provided by the nurse or Medical Assistant.
10. Wait time in the exam room before the provider arrived to see me.
11. Provider listened to my explanation of the problem and my concerns.
12. Provider answered my questions clearly and thoroughly.
13. Provider adequately explained my treatment options and the treatment plan.
14. Overall experience with the provider.
Check-in and Check-out Process
15. Courtesy and friendliness of staff.
16. Time required to check-in.
17. Time required to check-out.
18. Clarity of check-out instructions.
19. Professionalism of staff.
Billing and Referrals
20. Billing questions were answered clearly.
21. Staff was polite and helpful.
22. Timeliness of referral processing.
23. Follow-up by staff on questions.
Overall Evaluation of Service
Please add comments that you feel are helpful to explain your responses or for topics not covered by the form.
Survey Respondent Information: Please provide the general information below about yourself.
Sex:
Date of Birth:
Latest contact with the practice:
Purpose of last contact:
Date of last contact with the practice:
Name of your Primary Care Physician:
--- Select ---
Other
Bering, Harriet, MD
Bradley, Adrienne, MD
DeMarkles, Michael, MD
Derby, Lawson, MD
Driscoll, David, DO
Einhorn, Richard, MD
Ezzi, Pierre, MD
Garcia-Banigan, Dinamarie, MD
Handler, Alyssa, MD
Narusevicius, Lily MD
Pitroda, Arpita MD
Rizos, Demetrius DO
Rubel, Jeffrey MD
Ruff, Roy MD
Schwartz, David MD
Shih, Deborah MD
First Name:
Last Name:
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